Medical News Today, in mid-November carried a short story
on the recently released Child and Adolescent Mental Health Services (UK)review.
The report, which contains 20 recommendations for Government,
sets out a clear vision for how we can all take responsibility for promoting
children’s psychological well-being and mental health and how we can best
achieve a step change in the quality and consistency of services at all levels.
While there is much in this review to discuss – some
excellent and some less so, I want to focus on one of the recommendations that
addresses, (in part at least), the needs of youth – ages 18 to 25. Congratulations
– and it’s about time!
I remember sitting as a member of what was called the
Transitional Age Task Force in Toronto in the mid 1980’s (so the UK report is
only 20 years later – but at least they got to it which is more than I can say
for much of Canada) and working with various stakeholders to consider how to address
the mental health care needs of youth in this age group.
At that time the research was just coming in, and it was
showing that the majority of what had traditionally been considered to be
“adult” mental disorders actually onset during the late teens and early
twenties. Furthermore, nascent brain development research was identifying
substantial neurodevelopmental processes underway during those years – problems
or perturbations in which (such as defective pruning of dopamine receptors) was
being linked to major illnesses such as schizophrenia and bipolar disorder. Indeed,
we re-designed our “adolescent psychiatry unit” at Sunnybrook Hospital to
address this age group and did not know that we were in the vanguard of the
“first onset” movement.
So if such a high proportion of major mental disorders
(for example: depression; panic disorder, social anxiety disorder; bipolar
disorder; schizophrenia) onset during these years, why have we not designed
services to meet these needs. On the contrary, traditional mental health
services have hacked a gap between child and adult systems just when the need
for continuity and integrative care was most necessary. Why do child
mental health systems across Canada cut off around 17 – 18 years of age? What
reason is there to send a young person with unique developmental needs who is
struggling from the impact of a recent onset major mental illness to an “adult”
program that is not designed to meet her or his needs? It simply makes no
sense!
And, just before we get too complacent about this and say
something silly such as “the research is only just coming in” let's remind
ourselves that the ancient Greeks had already noted this. So did the
father of modern psychiatry Emil Kraepelin and the father of the study of adolescence
– George Stanley Hall (the later two
over 100 years ago – the Greeks of course were on to this centuries ago).
Whatever the reasons, and they would be speculations,
it's time now to throw out a system that does not meet the mental health needs
of young people and replace it with one that does. The CAMHS review is a
good start at the policy level. There are good pilot programs in Canada
and in Australia under the leadership of Dr. Patrick Mcgrory there is a
national initiative well underway.
I propose that we have a national forum on this topic –
and invite some international leaders and some of the young people that we had
the privilege to serve in Toronto some 20 years ago and some of the young
people that we are not serving well now. Perhaps now is the time.
~ Dr. Stan Kutcher
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